A biased look at psychology in the world

May 24, 2009

The Vaccination Wars (Part 1)

Although Jenny McCarthy and her fellow anti-vaccinationists still wage their very public crusade against vaccination, there's nothing really new about their arguments. Opposition to vaccination is as old as vaccination itself.

Smallpox was once one of the most devastating and feared diseases in history. As recently as the 18th century, frequent outbreaks killed an estimated 400,000 Europeans each year and left many survivors disfigured. Especially dangerous in children, 80% of those who contracted smallpox died of the disease. When Lady Ashley Wortley Montague arranged for her son and daughter to be inoculated against smallpox in 1717 (the practice was common in Asia but was unknown in Europe), she had no idea of the storm she would unleash as a result. Although early opposition to inoculation had a valid basis (patients undergoing the first inoculation technique, also known as variolation, had an estimated 3 percent chance of developing serious complications), much of the resistance came from religious leaders. In a July 8, 1722 lecture by Edmund Massey at St. Andrew's Church in Holborn, England, he based his sermon on a passage from the Book of Job, "So went Satan forth from the presence of the Lord and smote Job with boils, from the sole of his foot, unto his crown". Massey argued that the Biblical disease in question was smallpox and added, "With this view, I will not scruple to call it a diabolical operation, usurping an authority founded neither in nature or religion. This practice also tends to support vice and immorality, inasmuch as it diminishes the salutary terror which prevails respecting the uncertain approach of this disease". In other words, being afraid of smallpox built character.

Although Edward Jenner's discovery of vaccination meant a safer alternative to variolation, it would still take many years for vaccination to be widely accepted. In 1840, the British Parliament passed the first Vaccination Act which banned variolation. The Act also gave local boards the power to vaccinate everyone in their districts but still allowed individual objectors to refuse. While vaccination campaigns led to a dramatic drop in smallpox cases, outbreaks continued to occur (especially in the growing city slums). Following pressure from medical authorities, Parliament amended the act in 1853 to make vaccination compulsory. Not only were all newborns required to be vaccinated within the first three months of life but any parent refusing to comply was fined. By 1867, the law became even more stringent with parents being prosecuted for refusing to have their children vaccinated.

It was the stringent laws that inspired the development of the anti-vaccination movement in the 1870s. One of the leading figures in the movement was William Tebb who co-founded the London Society for the Abolition of Compulsory Vaccination in 1880 (it later became the National Anti-vaccination League in 1896). A lifelong firebrand, Tebb had been prosecuted thirteen times for refusing to vaccinate his third daughter. Along with his supporters, Tebb pushed for the abolition of the Vaccination Act and an end to compulsory vaccination in the UK and abroad. Realizing that the movement needed an eminent scientist to support the anti-vaccination cause, Tebb recruited an unlikely champion: Alfred Russel Wallace.

Although Wallace was already famous for his role in the development of Charles Darwin's theory of evolution, his willingness to take on unpopular causes had earned him considerable notoriety as well. Wallace had not always been an anti-vaccinationist (his earlier writings praised Edward Jenner as a medical pioneer and he had his own children vaccinated) but his involvement with Spiritualism brought him into regular contact with anti-vaccinationists (especially Tebb). It was Tebb who persuaded Wallace to join the movement by presenting him with statistics that he had compiled concerning the risks associated with vaccination. Whether due to the statistics or his own concerns about the basic infringements on individual freedom resulting from the Vaccination Act, Wallace became a convert to the cause sometime in the early 1880s.

In fairness to Wallace, there was probably was some basis for his skepticism. At the time, nobody knew exactly why vaccination worked. Despite Louis Pasteur's research and the recent acceptance of the germ theory of disease, the science of immunology was still in its infancy. The fact that medical authorities were eagerly pushing for something that the anti-vaccinationists were condemning as "quackery" and prosecuted parents who refused to comply was enough for Wallace to get involved. Working with the statistics that Tebb provided, Wallace began his own research into vaccination and the government statistics on smallpox and vaccination. He also attempted to link incidence of smallpox to more general issues of sanitation. While the Public Health Act of 1848 began to improve living conditions in most slums, progress remained slow and health problems related to sewage and industrial waste were still common. Wallace and his fellow anti-vaccinationists argued that smallpox and other infectious diseases were actually caused by contamination and that vaccination was likely dangerous in itself. There was (if you'll pardon the expression) a germ of truth in that since there was no generally accepted antiseptic guidelines in vaccinating children and doctors often reused the same needles on their patients. Wallace also argued that there were no controlled experiments showing how long the protection from vaccination lasted.

All of Wallace's findings were written up in a tract titled Forty-five Years of Registration Statistics, Proving Vaccination To Be Both Useless and Dangerous.Published in early 1885, Wallace compiled statistics from across Great Britain and continental Europe (where compulsory vaccination laws were also in place). Not limiting himself to smallpox, Wallace examined incidence patterns for diptheria, measles, scarlet fever, and whooping cough (pertussis). He concluded that vaccination did more harm than good and that public sanitation played a greater role in disease prevention. Almost immediately, Wallace came under attack by physicians who were horrified that a scientist of Wallace's reputation would side with the anti-vaccinationists. The fact that popular opinion was turning against mandatory vaccination (helped along by graphic stories of conscientious objectors being arrested), added to the pressure for changing the vaccination laws.